Voiding Dysfunction after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis

Area of Science:

• Gynecology
• Urology
• Surgical Oncology

Background:

• Deep endometriosis surgery, particularly involving the rectum, can lead to lower urinary tract dysfunction.
• The choice of surgical technique for deep endometriosis impacts postoperative voiding function.

Purpose of the Study:

• To systematically review and meta-analyze the rates of voiding dysfunction following different surgical techniques for deep endometriosis.
• To compare the incidence of postoperative voiding dysfunction associated with colorectal shaving, discoid excision, and segmental resection.

Main Methods:

• A systematic review of PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases was conducted.
• Studies were included if rated as good or fair quality, with two independent reviewers assessing quality.
• Thirteen studies were included in the meta-analysis, measuring the occurrence of postoperative voiding dysfunction.

Main Results:

• Rectal shaving was associated with significantly less postoperative voiding dysfunction compared to segmental colorectal resection (OR 0.34) and discoid excision (OR 0.22).
• No significant difference in voiding dysfunction was found between discoid excision and segmental colorectal resection (OR 0.74).
• Rectal shaving also showed a lower risk of requiring self-catheterization for over a month compared to segmental colorectal resection (OR 0.3).

Conclusions:

• Colorectal surgery for endometriosis impacts urinary function irrespective of the technique used.
• Rectal shaving appears to be associated with a lower incidence of postoperative voiding dysfunction compared to discoid excision and segmental resection.